I manage a small multi-specialty clinic in a suburban community. We have 5 MDs, 3 PAs and 30 employees. I have a clinical supervisor, a billing office manager, two certified coders, and several billing staff. We are very busy and I am not always sure we are collecting optimally, even though I meet with my key people monthly to go over the numbers. I see a lot of non-work-related chatter going on in the office, but I am told our people are stretched to their workload limits. Wondering if we are underperforming leaves me with a vague sense of unease. How can I satisfy my doubts about efficiency?
Concerned Practice Owner
Go with your gut. If your intuition is telling you that you suffer from poor performance, a closer look is warranted. Many practice owners and managers have the same worries as you, but unfortunately, few are able to invest the time and resources to confront the issues head-on. Most managers wait until cash-flow drops significantly before taking action. If you're not quite there yet, that's good. A proactive approach is always better. Below are a few ideas to get you moving in the right direction.
Examine your EOM reports. Look for trends in the following areas, breaking by payor, location, and provider: Gross charges, net charges (gross charges less contractual write-offs), net collections, percent collected of net charges, and average days outstanding. Problem areas may indicate systemic concerns requiring immediate attention.
Run aging reports at the account level. Hopefully, your PM system has some automatic follow-up tools that will ensure inactive claims get attention. Meet regularly with front line staff to review policies and procedures for denials management and follow-up. Simply hitting "re-file" is not follow-up! Even good employees are prone to do what is inspected, not expected.
Date stamp everything and check for time lags. At The Billing Pros we track date of service, date received by the billing office, and claim date. "Turn-around" reports tell us the average time between each step. If there is a problem, it will be important to know if it is in the billing/coding process or on the clinic side.
Be open to a different approach. Your front line staff will likely know if there are problems in your RCM process. They have an "on the ground" perspective that will likely yield some great ideas. Don't be afraid to experiment.
Call The Billing Pros. We specialize in peace of mind. Every day we work with providers and clinic managers who what to be paid fairly for their work. Contact us today to explore how our revenue cycle professionals can help.